> They lobby, they control the supply of doctors, they restrict competition, and they even engage in price fixing

It saddens me that those are your go-to ideas of what a union is.

> The AMA was key in killing Truman's universal healthcare proposal starting in 1945.

Actual unions have been pushing for universal healthcare for much earlier than I was born. On this front AMA has been the enemy of real organized labor for decades.

A real union is about workers banding together to stand up to a boss who says "fuck me or you're fired", or to resist management giving themselves millions while cutting pay for workers.

Please don't dishonor the good name of organized labor by comparing them to the millionaire doctors who killed our chances for a sane healthcare system.

I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make. Either way the goal is to get more money for members of the group. If you don't think doctors deserve the inflated value the AMA has captured for them but think that other union workers deserve more money then that's fair enough but practically it's the same game.

There's also a word for what you're doing. A tautology I think? It seems disingenuous to classify unions based on "good" value capture. It creates a position where unions literally can do no wrong because they'll just stop meeting your definition of union.

>I mean, the difference between "resist management giving themselves millions while cutting pay for workers" and "price fixing/restrict competition" is just an arbitrary, subjective distinction based on your opinion on how much money people should make.

Who would you prefer was paid more? Your doctor or his non-medical MBA manager?

Whichever leads to the best, most efficient medical industry and provides myself as a consumer with the most value.

According to the MBA manager, most efficient = most profits. And most value = more tests and more expenses by the 'consumer'. Looks like you are on with the Kool Aid!

No True Scotsman Fallacy https://en.wikipedia.org/wiki/No_true_Scotsman

Unions primarily engage in collective bargaining with the employers of their members. The AMA is not a union.

Very likely to be true and I wont disagree! I'm not actually even from the US so I'm unfamiliar with their scope. I disagree with the person I'm replying tos reasoning more than anything. Their objection was of a different nature than yours.

You're right, it isn't a union, it's a cartel!

No, a cartel is a group of competing firms in the same industry that form an alliance.

The best analogy for the AMA would be something like a guild.

No True Scots Union...

The dynamics of medical practice are changing substantially. Regional medical organizations are consolidating and creating vertically integrated medical behemoths.

As a result, MDs are losing their independence and becoming just another group of highly paid employees. Once big corporate entities take over, neutralizing noisy, highly paid employees is always part of the playbook.

That being said, when looking at the pie charts of where all the healthcare dollars go, MD/DO, and even nursing salaries are a tiny slice of the pie. Most of it goes to administrator and insurance fees, followed by nursing home and ICU level care, followed by hospital costs, medicine costs. AMA isn't really the big problem here.

That Washington Post article is a straight up hit piece on the Relative Value Update Committee.

Here's how medical compensation is decided in the US (simple simple SIMPLE edition):

All office visits, procedures, labs, radiology tests, everything, are assigned a CPT code. That code is then assigned a relative value unit (RVU) to determine the amount of "work" each code represents. The RVU itself has three components--Physician Work, Practice Expense, and (expected) Malpractice Expense.

These arrive at some number or RVUs. To then determine compensation, CMS (and insurers) use the following formula:

[(Work RVU * Work GPCI) + (Facility or Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * [Conversion Factor adjusted for budget neutrality] = $Compensation for a given CPT.

GPCI - Geographic Price Cost Index, and represents a regional adjustment for a given cost of services.

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The Post article acts like it's some big conspiracy that the RVU numbers haven't really changed much as if that's the reason healthcare costs are rising so rapidly. Except, the RVU itself doesn't determine the compensation. The values of a single RVU is determined arbitrarily by Medicare and Insurers. The whole point of the RVU committee is the make sure that all various parts of medicine are weighted according to some arbitrary value scale. You shouldn't expect Colonoscopies to suddenly become worth less RVUs just as time progresses. The "value" provided by a colonoscopy as technology progresses possibly counteracts the decrease in costs. I can tell you in Radiology that more resolution = more things to evaluate and = requires time to interpret the study despite a study acquisition time now in seconds.

CMS changing how much each RVU is worth is what determines what gets paid out. And I can tell you, CMS pays less for each RVU as time goes on.

http://www.acro.org/washington/rvu.pdf

The AMA doesn't restrict the number of doctors really either.. that's an old trope that isn't really true. The number of doctors is restricted by the number of residency slots available, which is restricted by congressional funding since they're all paid for via Medicare. If congress were serious about increasing the number of doctors, they could pass a bill tomorrow authorizing more money for new residency programs.

We've dramatically increased the number of medical students but haven't kept up in residency spots.

NEJM lays it out:

http://www.nejm.org/doi/full/10.1056/NEJMp1306445?viewType=P...